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Wear a helmet: It's worth it

No matter what the activity, if speed's involved, a helmet is needed

By James Fell, Special to Tribune Newspapers

7:19 PM EST, February 27, 2013

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Two weeks later and the muscles in my neck are still sore.

It wasn't my fault. She took a sharp turn right into me without looking, clipped my skis and sent me spinning. I ended up falling backward downhill and smashing the back of my head hard against the snow at Lake Louise ski resort in Canada's Banff National Park.

My neck hurts, but my brain is fine. I was wearing a helmet.

It was a Christmas gift from my family-physician wife 11 years ago. "Oh, a helmet," I said upon unwrapping it. "Great." (Note: sarcasm.) But then I put it on and found it was warmer and more comfortable than a winter cap. I was sold. In fact, I'm a dedicated helmet wearer for cycling, in-line skating and even sledding. For 11 years I've always worn a helmet in these activities and never once needed it. Until I needed it badly.

Seriously, it was a bad crash. I can't imagine how much my brain would have been rattled with an unprotected skull.

Collision sports such as hockey and football make helmets a "Well, duh," but you can get a concussion from any sport at any time. If there is velocity involved, you're at risk.

"People don't realize the velocity they can attain," says Dr. Allen Sills, an associate professor of neurological surgery at Vanderbilt University Medical Center in Nashville, Tenn. "It's not unusual for a recreational skier to exceed 50 mph, and even falling on soft snow can result in significant injury."

For bicyclists, there is no federal law mandating helmet use, and according to the Bicycle Helmet Safety Institute, only 22 states plus D.C. have statewide laws, but most of these are limited to those under 18. After that, you're old enough to vote … for a possible brain injury.

"The best evidence is in bicycling, that head injuries are significantly reducing by using helmets," said Dr. Laura Purcell, a specialist in pediatric sports medicine at McMaster University in Ontario. Vote wisely.

When it comes to skiing and snowboarding, there are no laws in the U.S. mandating use, even though a review last year by Johns Hopkins University researchers found that helmets clearly reduce the risk and severity of head injury from these activities, while not increasing neck injuries or causing compensating behavior like "I have a helmet, so I can ski drunk with my eyes closed."

So just how does a helmet help? "A number of well-documented studies show a helmet used in high-velocity sports reduces injury, particularly in regard to skull fractures," Sills said.

"Additionally, it can reduce some of the energy that is transmitted to the brain." Having energy transmitted to the brain is bad. It's physical energy; it's what causes concussions.

How much the brain absorbs depends on padding of the helmet and the nature of the crash. "Many times there is a rotational component," Sills said. "The head is turning and causes the brain to move inside the skull, and the helmet can't prevent damage from that." Fortunately for me, there was no rotation involved when my head impacted the snow.

As a wife-enforced early adopter, I've seen a growing number of people on the slopes and bike paths wearing helmets, and contemplated the trend toward enhanced safety.

"The professionals in each sport drive the adoption," Sills told me. "Recreational snowboarders adopted helmets before skiers from watching competitors in the X Games. The same is true in bike racing." In the 2000 Tour de France, few riders wore helmets, but by 2006 that had changed. "When people see the pros wear helmets, they want to as well." Sills also states that parents are instrumental role models, especially in recreational sports where kids may not think of wearing a helmet, such as skating or sledding.

"Parents are key," agrees Purcell. "They need to model behavior by wearing helmets." Not only that, but they need to make sure the helmets are worn properly. Purcell told me of the "2V1" rule to ensure proper fit: The top of the helmet should be "two" finger widths from the eyebrows, the strap should form a "V" under the ear, and there should be room for just "one" finger between chin and chin strap.

And parents need to think beyond the obvious. Sills says any activity that involves velocity puts you at risk, but there are many high-speed sports that people don't consider helmet-worthy. I've noticed only a small portion of people at roller rinks wear helmets, and the protective gear is rare on the sled hill as well. "There are no specific toboggan helmets so people don't think about it," said Sills.

"We see a disproportionate number of head injuries from the sledding hill compared to skiers and snowboarders," said Craig McArthur, a paramedic in the ski town of Banff, Alberta, and also my best friend. "A lot of these kids have ski helmets, but don't think to wear them while sledding."

But a 2010 analysis of the research of sledding injuries that appeared in the journal Pediatrics showed the head was the most commonly injured body part (34 percent of injuries requiring a hospital visit), and that overall, 9 percent of sledding injuries involved a traumatic brain injury. People have died from a sledding-induced brain injury.

As good as helmets are for reducing risk, concussions can still happen. Purcell said people with a concussion will have a headache, confusion, nausea, dizziness or balance problems. If this happens, stop the activity and seek medical assistance.

Any recreational activity where there is velocity, consider the potential impact this may have on your cognitive capabilities. Your brain is where you live, and it's worth protecting.

Neighbor's kid missing a helmet?

I've become evangelical about the importance of wearing helmets. When taking a neighbor's kid biking with mine, I will ask their parents if they have a helmet they can wear. "Uh, no, they don't," one parent said. "That's OK," I said. "We have an extra." Next time that kid went biking with us, they had their own helmet.